The
Statins and Other Cholesterol-lowering Medications in the
Presence
of Glaucoma
McGwin, G. Jr., et al, Archives of Ophthalmology,
June 2004.
Conclusions: There is the intriguing possibility
that long-term use of oral statins may be associated with a
reduced risk of open-angle glaucoma, particularly among those
with cardiovascular and lipid diseases.
Select Quotes:
“The use of HMG reductase inhibitors may have a direct, causal
relationship in reducing cholesterol production and enhancing
low-density lipoprotein cholesterol removal from plasma. To
the extent that excess total cholesterol or low-density lipoprotein
cholesterol is implicated in these conditions, the use of the
statins would reduce the risk of developing these conditions,
or at least delay their onset.”
“The new statins also inhibit rho-kinase activity, which has
been shown to increase aqueous outflow.”
“There are plausible means by which statin use could be associated
with a reduced risk of developing glaucoma. By reducing atherosclerotic
processes and subsequent vascular diseases, statins may directly
protect optic nerve head vasculature, or may indirectly improve
ocular blood flow.
“The results of this analysis demonstrate a significant and
meaningful association between glaucoma and long-term statin
use. “
“Many statins inhibit the activity of rho-kinase; such inhibition
has been shown to enhance aqueous outflow and thereby presumably
lower intraocular pressure. The ability of statins to reduce
cardiovascular disease may directly or indirectly protect the
vascular supply to the optic nerve.”
“If the trend and magnitude of effect seen with statin use
of greater than 23 months is upheld with larger sample sizes
in future studies, the protective effect with rival that of
lowering intraocular pressure through the use of medications
discussed in the Ocular Hypertensive Treatment Study. This
would also imply that a new therapeutic class of agents might
be effective for the care and treatment of patients with glaucoma.”
“Additional work is also needed to clarify the nature of the
association between the presence of lipid disorders and the
use of medications to lower lipids. If these findings are corroborated
with other studies, ‘a randomized clinical trial of the use
of statins or other anti-lipid/cholesterol-lowering agents,’
may lead to the application of a new class of medications for
the treatment of glaucoma.
M & T Commentary:
We are always intrigued to see the discovery of new and unique
associations that might influence the ultimate outcome of
a chronic disease. It will certainly be interesting to follow
this potential association, and we would ask that each of
you maintain an objective, but heightened observation of
your patients with glaucoma who are also taking the statin
drugs. Only when thousands of patients are followed by thousands
of keen observers can a consensus of effect be truly established.
We urge you to be vigilant in your observations of patients
taking statins who have a diagnosis of glaucoma. |
